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Exercise Addiction
Mova Morrisette and Len Kravitz, Ph.D.

Introduction
One of the personal trainer’s and fitness professional’s primary duties is to ensure that the client exercises safely and effectively to successfully reach his/her goals. This involves proper exercise technique, correct exercise choice, and a progressive fitness program combined with the motivational guidance and leadership of the fitness professional. However, some clients, as well as their personal trainers, may be unhealthily over-exercising. Do you have a “model client” who originally did almost no exercise, but now exercises too much? Have you recently accepted a new client who is already in excellent physical shape, but who wants your assistance in the pursuit of perfection? Does one of your clients consistently ignore both your advice and that of their MD, and continue to exercise vigorously even though doing so worsens an injury or illness? If so, you may have a client who is addicted to exercise. There are several names for this problem: a Medline keyword search will reveal literature on exercise addiction, excessive exercise, compulsive exercise, exercise dependence, overexercising, and obligatory exercise. They all address essentially the same problem; that of people who exercise to a point that is detrimental to their health. To avoid unnecessary complication, in this article, the term “exercise addiction” will be utilized. This article will attempt to bring forward an awareness and education of this deleterious aspect of exercise and provide the fitness specialist with direction how deal with this unwanted behavior.

What are the common clinical indicators of a dependence (addiction) and compulsion?
Common, clinically significant psychological indicators that a behavior may have become abnormal include:
a) The behavior is no longer under voluntary control
b) The behavior causes distress for self and/or others
c) The behavior interferes with normal life functioning
d) The behavior is engaged in to prevent symptoms of withdrawal
e) The behavior escalates (indicating an increased tolerance to effects of the behavior)


What are the clinical psychological indicators as applied to exercise addiction?
Because exercise is normally a healthy behavior, an addiction to exercise, unlike for instance, an addiction to a drug, may be difficult to recognize. Most human behaviors are considered normal and beneficial unless they are taken to extremes. Therefore, a personal trainer who wonders whether a client is addicted to exercise needs to try to assess whether the behavior is within the normal range, or whether it has become excessive.
a) Does the person indicate that the activity is no longer under their voluntary control?
Lack of voluntary control in this case means that a client who already follows a comprehensive exercise routine increases the frequency, intensity, and duration of exercise beyond the prescribed amount, on a regular basis. This person may feel a compulsion to regularly exercise beyond healthy doses.
This client may or may not recognize that she/he is no longer in control of their exercise behavior and may not realize this additional time is negatively impacting other important activities in daily life.

b) Is the amount or intensity of the exercise causing distress for the person or others?
Is it causing emotional distress? An athlete in training, especially one who is still in school, or who must work, may consider it legitimate to spend all of his or her spare time exercising. In this case family and friends often accept the heavy training schedule, because a specific performance is the goal, and a more normal lifestyle will resume after the event. However, what about the recreational exercise enthusiast who exercises constantly, and feels she/he can never exercise enough (there will be more on this topic in the section on escalation). Additionally, family and friends may be distressed by the fact that the person no longer interacts as much with them. The American Psychological Association’s Diagnostic and Statistical Manual, Fourth Edition (DSM-IV) lists significant problems with relationships as one of the diagnostic criteria for dependence, compulsive, and pathological behaviors (DMV-IV-TR, 2000).
Is the amount of exercise causing physiological distress? Most people who exercise regularly occasionally over-do it. This is not a sign of addiction. A problem may be indicated when the person constantly over-exercises. Has the person’s exercise routine increased so much that it has become detrimental to their physical health? Are their dietary needs being met? If you have prescribed a periodized training routine, does the client comply with the scheduled reductions in training? If you ask them questions like those listed above, do they respond to your concerns in a logical, healthy way, by honestly considering the merits of reducing the type or amount of exercise? Are they willing to adjust water, nutrient, and food intake so that they remain healthy? If so, the person may be just very serious about exercise, not addicted (see below). If they continue to over-exercise, and/or under-eat, further assessment is merited.

c) Is the exercise interfering with normal life functioning?
Again, keep in mind that there are healthy people who are so enthusiastic about exercise that it becomes a major part of their life, and they spend the majority of their free time engaged in it (Ackard, et al., 2002). This is OK! However, those who are desperate to reach an unattainable goal of perfection through exercise may be addicted. To help figure out whether a problem is present, the following questions can be asked:
1) Is the time and effort spent exercising interfering with personal relationships? In addition to quality time with family and friends, does the client appear to have an active interest in a romantic relationship with a significant other? Again, these concerns might be temporarily set aside in the pursuit of a specific goal, but they should remain important to the person.
2) Does exercise increasingly interfere with work or school? When a person is first starting an exercise routine, especially in the morning or during a lunch hour, he or she may be late to work a couple of times, and then adjust their schedule as needed. A person who is serious about developing and maintaining a healthy lifestyle may even eventually change job schedules or reduce the amount of over-time that they work so that they can accomplish their goal. This is normal.
On the other hand, frequent, ‘unexcused’ absenteeism from work or school, so that the time can be spent exercising, is not normal. If this behavior continues or escalates in the face of increasing problems at work, and/or dropping grades at school, it may be an indicator of addiction to exercise. Again, the DSM-IV lists interference with occupational or social activities as one of the criteria for abnormal behaviors (DSM-IV-TR, 2000).
3) Does exercise create a disproportionate financial drain? Exercise equipment and clothing can be expensive, and are often used as motivators by those who are exercising. However, a situation in which a person is missing so much work (due to exercising, recovering from, or preparing to exercise) that they can no longer successfully pay the bills, and /or is spending more than they can afford on equipment may be an indicator that a problem exists.

d) Does the client exercise in order to prevent withdrawal symptoms?
This issue is not as straightforward for exercise as it is for other addictions. It must be addressed in the context of the client’s life and exercise history because anyone who has been exercising regularly is going to notice a set of symptoms if they stop. Exercise in proper amounts is a physically and psychologically healthy activity that elevates mood and reduces stress, anxiety and depression. So is there a way to know if the client is exercising to be healthy, as opposed to exercising to prevent withdrawal symptoms?
Essentially, this can be assessed by looking at a combination of why the client exercises, and from the client’s reaction to inability to exercise (Ackard et. al., 2002; Cockerill & Riddington, 1996). The client with an exercise addiction may feel and express such an increased amount of stress due to lack of exercise at their normal intensity (or frequency and duration) that it begins to look as though he or she has built up a need for the psychological and physiological responses to exercise (Davis & Woodside, 2002). This client is likely to continue to exercise at their present level in spite of advice not to do so, and/or he or she may use unhealthy means to cope with the increased stress (substance abuse, temper tantrums, etc.) caused by withdrawal from their normal amount of exercise. This may especially occur with clients who use excessive exercise as their primary mechanism for mood enhancement or as a coping mechanism for stress or depression (Anshel 1991).

e) Is the amount and intensity of the exercise behavior escalating?
This is another issue that must be dealt with in the context of the person’s exercise
history. For example, someone who just recently began an exercise routine that, say, included 20 minutes of low-intensity aerobics 3 days a week with a couple of rounds of circuit program on an alternating days of the week can legitimately and easily increase duration, frequency, and intensity in scheduled healthy amounts. Contrariwise, a client who has developed an addiction to exercise may already be exercising at an optimal level, yet still increase the intensity, duration and frequency of exercise because they have built up a tolerance to the psychological and physiological effects of exercise (Davis & Woodside, 2002). Examples of this include people with the desire to achieve perfection in performance, and those with perfectionistic body image issues (Flett and Hewitt, 2005). The desire for size or strength can have a similar effect; one might feel that one could be larger or stronger if they just lifted more. It is a good idea to watch for dangerous technique and/or improper substance use in these cases. Also, those who use exercise as a primary coping mechanism for chronic stress or depression may be especially at risk for escalating exercise behavior (Anshel, 1991). Because the body adjusts to each increase in exercise, the person may feel the need to exercise more and more to achieve the physiological changes that result in stress reduction or depression management.


STOP! I’m a personal trainer and fitness professional! Not a psychologist!
First, and most important: Do not attempt to label the client (or yourself) an exercise addict. There are several reasons for this:
1) Only a licensed psychologist or psychiatrist can actually make a diagnosis of exercise addiction.
2) Clients may be extremely insulted by the suggestion that they have a psychological problem. Saying so outright is unlikely to get good results.
3) Labeling devalues their worth as a person by making it seem as though nothing else about them matters.
4) If you label the client, you make it harder for yourself to approach them with a neutral, professional manner.
Take a step back! Watch the client for a few weeks. Excessive exercising may be a temporary response to a passing source of stress such as getting fired, divorced or a personal crisis. If the person returns to healthy exercise levels, this was not a true exercise addiction. If you are in doubt, consult with a trusted colleague of the client, but remember to maintain confidentiality.
If you decide to approach the client, try to keep the interactions relaxed, positive, conversational and very low-key. You needn’t say anything at all about being “worried about an exercise addiction”. Instead, say something like “I may be off-base, but you seem a little stressed these days. Is anything going on?” The reply that you receive, and the conversations that follow it, will help you to make an informed decision.

As with all sensitive interactions with individuals, perhaps role-playing in your mind ahead of time is warranted. Rehearse discussing the issue without saying anything about addiction or needing to see a psychologist, etc. It is important to remember that a true exercise addiction is rare. Most people who are avid exercisers are physically and psychologically healthy (Cockerill & Riddington, 1996, Ackard, et al., 2002). Successfully handling a situation like this requires compassion, professionalism, and a sincere understanding of your client.

References:
Ackard, D.M., Brehm, B.J. & Steffen, J.J. 2002. Exercise and Eating Disorders in College-Aged Women: Profiling Excessive Exercisers. Eating Disorders, 10, 31 – 47.
American Psychiatric Association, 2000. Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington DC: American Psychiatric Association.
Anshel, M.H., 1991. A psycho-behavioral analysis of addicted vs. non-addicted male and female exercisers. Journal of Sport Behavior, 14(2), 145-154.
Cockerill, I.M. & Riddington, M.E. 1996. Exercise Dependence and Associated Disorders: A Review. Counseling Psychology Quarterly, 9 (2), 119-129.
Davis, C. & Woodside, D.B. 2002. Sensitivity to the Rewarding effects of Food and Exercise in the Eating Disorders. Comprehensive Psychiatry, 43 (3), 189 – 194.
Flett, G.L., & Hewitt, P.L. 2005. The Perils of Perfectionism in Sports and Exercise. Current Directions in Psychological Science, 14(1), 14 – 18.

Bios:
Nova Morrisette has a Bachelor's Degree in Psychology, two years of experience as a Research Assistant in Psychology, and 23 years of practice as a nurse. She is presently a Master's student in Exercise Science at the University of New Mexico. Her research interests involve the creation and maintenance of healthy eating and exercise habits in previously sedentary populations.
Len Kravitz, PhD, is the program coordinator of exercise science and a researcher at UNMA, where he won the 2004 Outstanding Teacher of the Year Award. He was also honored with the 1999 Canadian Fitness Professionals International Presenter of the Year Award, and was the first person to win the IDEA Fitness Instructor of the Year Award.